Healthcare Provider Details

I. General information

NPI: 1215079371
Provider Name (Legal Business Name): CHRISTOPHER D. SMITH, DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 COLLEGE AVE
MANHATTAN KS
66502-2770
US

IV. Provider business mailing address

1133 COLLEGE AVE BLDG D, SUITE #110
MANHATTAN KS
66502-2770
US

V. Phone/Fax

Practice location:
  • Phone: 785-770-3300
  • Fax:
Mailing address:
  • Phone: 785-770-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CHRISTOPHER D SMITH
Title or Position: OWNER
Credential: D.D.S, M.S
Phone: 785-770-3300